Understanding disparities for those with severe mental illness, particularly those with schizophrenia, is essential as these individuals have the most difficulty navigating the U.S. health care system. Schizophrenia is chronic, associated with substantial disability, and poses a large burden to society, with minorities bearing a larger share of this burden in the U.S. Although there is some evidence of black-white disparities in quality of schizophrenia care, little research is available for Latinos or about temporal trends. We do not know whether geographic variation in patterns of care contribute to disparities; nor do we know the role of characteristics of the communities where patients live in disparities. This proposal seeks to detect and understand disparities for black and Latino Medicaid beneficiaries with schizophrenia using longitudinal data from four racially/ethnically and geographically diverse states. We aim to (1) assess disparities in quality of care and to systematically estimate the contribution of county-level factors to disparities; (2) assess disparities in diffusion rates of innovative treatments and to systematically estimate the contribution of county-level factors to disparities; and (3) investigate policies associated with equity through detailed interviews with policy-makers and other key individuals based at high- and low-performing counties identified in Aim (1). By gathering evidence of the contextual factors associated with disparities, we will provide concrete targets for reform, priorities for resource allocation, and policy levers in the service of equity. PUBLIC HEALTH RELEVANCE: The proposed research has public health relevance because in addition to documenting the existence of health care disparities for publicly insured people with schizophrenia we seek to elucidate contextual factors associated with disparities at the local level. This kind of granular knowledge can be extremely valuable to public policy efforts aimed at improving quality and equity of care.